IF IT'S Monday, your smartphone might remind you, you should probably be thinking about quitting smoking. Your odds of being diagnosed with the MERS virus are 1 in 150 based on other cases in your city. Oh, and don't worry — your blood pressure has stayed steady with your latest prescription. No need to see the doctor.
These are only a handful of the insights that e-health, or the use of remote technology to provide medical care, could someday tell us and our doctors about how we live. The idea that a computer screen, a cellphone, or even a wearable wristband could revolutionize medicine isn't exactly far-fetched. Already, tools exist to measure, communicate, and even analyze health conditions in ways that can dramatically help clinicians treat patients, even from thousands of miles away.
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The Affordable Care Act incentivizes hospitals and health systems to do more patient care in outpatient settings. By some estimates, mobile health in the United States could easily become a billion-dollar industry. With its world-class hospitals and burgeoning startup community, Boston is a natural home to build groundbreaking e-health infrastructure.
Yet there's an old joke in health care circles about medical imaging technology: It's the "technology of the future, and always has been." And, a few decades from now, it's not hard to imagine the same joke being told about e-health.
So why hasn't health care experienced the same growth in innovation that has been seen in retail sales, travel, or social networking? Why haven't doctors and other providers created more advanced e-health tools that have improved health care? What is keeping the tech industry and the medical field from building these products together? As a clinician, researcher, and entrepreneur, I've come to understand that the barriers to e-health are both economic and cultural — in medicine and tech. Now is the time to bridge those divides.
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The most obvious place to start is an overhaul of how we fund health technology.
Traditionally, medical research has been financed largely by government money, most famously through the National Institutes of Health. But consider what it takes to get a NIH grant, big or small: Applying itself takes a minimum of six months, between organizing one's thoughts, lining up collaborators, and getting the extensive institutional paperwork in order. Then another six months or more goes by as the application is reviewed and, in the best-case scenario, the proposal is approved and funded. And once my project is approved, I'm expected to complete the research I've set out to perform, with only a modest variation allowed in a research plan that will span three years or longer.
This funding approach must be rethought. In the tech world, three years might as well be a millennium. In a field where the value of intellectual property is said to have the lifespan of a banana, it's crucial that research and development be done at a breakneck speed. Most of the time the only plan an innovator starts with is to use initial beta results to inform the modification of a software program, algorithm, or device — so as to immediately improve the next version. In theory, understanding the human body requires a different approach than garnering more clicks for a website. But many of the biggest challenges in the e-health sphere will depend on convincing patients to open a certain app or reminding people to take medications at a certain time.
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At the same time, the symbiotic relationship that had once existed between academia and industry has eroded. In previous decades, promising findings from basic science labs at universities would be passed off to private firms, which would then turn them into drugs or devices before returning to academic medical centers to test the final product in clinical trials. This system kept things neat. One entity performed the research; the other took on the commercial risk.
Today, however, those promising breakthroughs are as likely to come from the second or third or 50th iteration of a product than at its conception. And who, in that scenario, owns the intellectual property? Hospitals are starting to realize that algorithms for using health information may have as much value as a drug compound. Tech companies — funded by investors who are used to owning IP as the main way to get a return on investment — are wary of giving away potential profits. This tension inevitably makes collaboration even more complicated.
Then there are the questions of patient privacy and regulation. The Health Insurance Portability and Accountability Act, or as most people know it, HIPAA, creates enormous challenges. In fact, it's one of the biggest obstacles for e-health innovation. HIPAA severely restricts how medical data can be collected, stored, and transferred. That may add some layer of protection for patients, but it also leaves open important unknowns about how and whether data can be ultimately used. From the viewpoint of investors and even researchers themselves, unless such issues around HIPAA are resolved, the uncertainty can be far too risky to spend thousands or even millions of dollars on a novel project. The Food and Drug Administration, in its recent report on information technology in health care, has started the process of laying out a framework for how smartphones, computers, and other devices store and transmit medical data. While this is an important first step, there is a long way to go for regulation of the field to be clear.
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Beyond these technical concerns, however, health care may be one industry that is fundamentally not set up to absorb outside innovation easily. The medical system is often anachronistic and guild-like. It's also a field that requires collaboration and cooperation with not only colleagues but also the system itself in order to succeed. While most markets require a buyer and a seller alone, health care has a bevy of stakeholders that need to be satisfied — the patient, the doctor, the hospital, and the payer (in most cases, insurance companies). All of these groups have interests that at times overlap, but often contradict each other. So, an app that patients love might go nowhere if doctors find the end data to be clinically irrelevant or difficult to interpret.
Nonetheless, the tech community is ready to work with all these various stakeholders to find the next generation of health solutions.
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A few years ago, I was invited to lecture to students in Stanford's computer-science department. I was intimidated — I figured half of the class would soon be starting companies with higher market caps than the GDPs of small countries. But I was met by an enthusiastic crowd. I was offering these future innovators real-world problems to work on and solve. In fact, I heard from many of them afterward. Using technology to address health challenges was something they were far more passionate about than creating the next Facebook. Medicine touches us and our loved ones in profound ways that "Angry Birds" does not. And this alone should be enough to do what we can to ease the way to the next frontier in e-health.
Dr. Niels Rosenquist, a psychiatrist and economist, runs Boston-based Janys Analytics. He is also the co-founder of 2Know.inc, an e-health startup.